Abstract
BackgroundInfection is the second leading cause of mortality in patients who undergo maintenance hemodialysis. In this population, impairment in both cellular and humoral immunity contributes to the increased incidence of infection and infection-related hospitalization. However, these artificial devices occasionally enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients.Case presentationA 54-year-old male undergoing maintenance hemodialysis was hospitalized because of the acute onset pain in the back and bilateral legs and declining consciousness which started at 7 days after the treatment of herpes zoster-related neuralgia with continuous epidural anesthesia. Physical examination revealed purulent discharge from the insertion site of the catheter. Serum biochemical tests showed increased inflammatory response and malnutrition. Magnetic resonance imaging revealed meningitis and multiple abscesses in the iliopsoas, erector spinae, gluteus medius, and vastus lateralis muscles, where conventional antibiotic treatment often fails to cure. Staphylococcus aureus was detected in the cerebrospinal fluid. Combination of intravenous antibiotics treatment and aggressive open surgical drainage of the muscle abscesses finally cured meningitis and multiple deep muscle abscesses in this patient.ConclusionsTreatment with sensitive antibiotics and timely open surgical drainage is necessary to cure catheter-related meningitis and secondary deep muscle abscesses in hemodialysis patients. Our case also suggests that epidural anesthesia may not be a good therapeutic option for herpes zoster because patients with herpes zoster are immunologically more compromised during and shortly after reactivation of varicella zoster virus.
Highlights
Infection is the second leading cause of mortality in patients who undergo maintenance hemodialysis
Our case suggests that epidural anesthesia may not be a good therapeutic option for herpes zoster because patients with herpes zoster are immunologically more compromised during and shortly after reactivation of varicella zoster virus
When patients are being affected by herpes zoster, it is unclear whether epidural anesthesia for pain control is a safe treatment, especially in hemodialysis patients
Summary
We presented here the case of a male patient receiving maintenance hemodialysis, whose bacterial meningitis and multiple abscess in the deep muscles were related to the indwelling epidural catheter and were successfully treated with antibiotics treatment and open surgical drainage. All authors read and approved the final manuscript. Ethics approval and consent to participate A written informed consent was given by the patient to participate in this case report study. Consent for publication A written informed consent was given by the patient to publish this case report. Author details 1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Author details 1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. 2Division of Nephrology, Maeda Hospital, 2742-1 Tachibana-cho, Imari, Saga 848-0027, Japan. 3Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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